Accelerating e-Prescribing

Leader: EHRs Necessary To Boost Quality of U.S. Health Care System

In a San Francisco Chronicle opinion piece, Robert Pearl, executive director and CEO of the Permanente Medical Group in California, argues, "Providing the best health care in the 21st century requires a relentless pursuit of prevention, a comprehensive electronic [health] record, powerful online applications and a commitment to patient safety."

Pearl writes, "The American health care system is archaic, fragmented and paper-based. As a result, it's highly ineffective. As the Obama administration starts to tackle the task of providing health coverage to all, it's important that we use the opportunity to advance American medicine into the 21st century."

Pearl concludes, "It's time to apply to health care the knowledge and tools that have revolutionized and improved other aspects of modern life. We owe it to all Americans."

American Recovery and Reinvestment Act

For more information about the "Stimulus Package " visit: http://www.healthtransformation.net/cs/stimulus_package_hit

Free e-Prescribing Solution Helps Physicians Ease into e-Prescribing

  CHT founder Newt Gingrich recently said, "In the 21st century, the legibility of a doctor's handwriting should not determine whether a patient lives or dies." Unfortunately, this does occur and according to the Instutute of Medicine's 2006 report, over 7,000 people died and 1.5 million Americans injured by preventable medication errors each year. Studies indicate that most physicians have been reluctant to adopt electronic prescribing primarily because of the cost of the systems and the perception that the technology requires too much time to learn and install.  Currently, only about one-fifth of U.S. doctors are prescribing drugs electronically.

Hoping to address this issue, a coalition of some of the nation's most prominent technology companies and leading healthcare organizations are offering free electronic prescribing for every physician in America.  Led by Allscripts, other sponsors include Cisco Systems Corp., Fujitsu Computers of America, Inc., Google, Inc. (the coalition's Search Sponsor), Microsoft, Corp., Intel, Sprint Nextel Corp., SureScripts, Inc., and Wolters Kluwer Health, Inc.

Another key element of the NEPSI initiative is the participation of two of the largest health benefits companies in the U.S., Aetna and WellPoint.  The coalition's health benefit sponsors will provide a range of incentives to physicians in their networks to encourage adoption and use of electronic prescribing technology.  The backbone of the NEPSI program is eRx NOW™, Web-based software from Allscripts powered by the same engine used today by more than 20,000 physicians to write millions of electronic prescriptions each year.  Designed to appeal to physicians in solo practice or small groups, eRx NOW™ is available free to any healthcare provider with legal authority to prescribe medications, and requires no download, no new hardware, and minimal training. 

Doctors are invited to register for the program online at NationaleRx.com.

Final Stimulus Package Includes HIT

The new Federal Government’s stimulus package -- the American Recovery and Reinvestment Act of 2009 -- provides many benefits and some new restrictions on physicians, hospitals, nursing facilities, educational institutions, and vendors. However, mostly, the Act provides some new sources of funding for health information technology (HIT). It also provides for grant funding to educational institutions which teach HIT as part of their curriculum. The Act also provides incentive payments to physicians, hospitals, and nursing facilities for the adoption and implementation of HIT, including electronic health records (EHRs). However, the Act also increases privacy and security protections for health information and entities that may use or access such information.

First, EHRs and HIT are to be promoted by the Office of the National Coordinator for Health Information Technology (ONCHIT or “Office”). ONCHIT was previously created by Executive Order. ONCHIT is to oversee HIT Policy and Standards Committees. Its duties include the integration of HIT and the utilization of EHRs for each person in the United States by 2014.

The Secretary of Health and Human Services (HHS) is to invest in the infrastructure necessary to promote and allow for the electronic exchange and use of health information.  The Secretary may award grants to States to facilitate and expand the electronic exchange and use of health information. Grants may also be made for loans to health care providers to purchase or enhance EHRs or train personnel.

Educational assistance will be provided to institutions of higher learning through Research Centers and a HIT extension program. HIT Regional Extension Centers are to provide technical assistance and information obtained from the Center to support regional efforts.  The Secretary may award grants to develop academic curricula integrating certified EHRs into clinical education of health professionals.

Separately, the Secretary is to provide assistance to higher education institutions to establish or expand medical health informatics programs, including certification, undergraduate, and masters degree programs for both health care and IT students.

Incentives are also a large part of the stimulus package. Incentives will be provided under the Medicare program for the adoption and meaningful use of certified EHRs. The incentive is to be paid to an eligible professional, including physicians, Medicare Advantage providers, hospitals, Medicaid providers, and nursing facilities. Payment is only made for the “meaningful” use of an EHR, which includes e-prescribing, connection with other EHRs, and reporting of clinical quality measures.

CCHIT Creates Fast Track Certification Process for Stand-Alone e-Prescribing Systems

The Certification Commission for Healthcare Information Technology is fast-tracking the certification process for stand-alone electronic-prescribing systems to help clinicians comply with legislation. CHT Project Director David Merritt serves as CCHIT commissioner and believes the process will help accelerate the adoption of e-prescribing technologies. The certification cycle for stand-alone systems has been expedited because of the new Medicare bonus payments to providers who use a certified e-prescribing system with certain features, CCHIT said.

CHT Member MinuteClinic Collaborates with Cleveland Clinic

CHT member MinuteClinic, a pioneer in the emerging retail healthcare space has entered into an arragement with the Cleveland Clinic for the provision of clinical care as a convenient, seven-day-a-week option for those with acute minor illnesses.

Sharing a core value of providing the highest quality care, MinuteClinic distinguishes itself as the first and only retail health care provider to receive accreditation from The Joint Commission, the national evaluation and certifying agency for nearly 15,000 health care organizations and programs in the United States.

"This relationship will demonstrate a true continuity of care model in Northeast Ohio," states David Bronson, M.D., Chair, Medicine Institute, Cleveland Clinic. "Consumers today want access, affordability and coordinated care at all levels. This collaboration with MinuteClinic enhances this innovative solution and addresses those needs while providing quality medical care for acute minor illnesses."

 

By the end of 2009, the collaboration will include nine locations in northeast Ohio, each one staffed by a MinuteClinic nurse practitioner with clinical consultation provided by a Cleveland Clinic Health System-appointed Medical Director. The first location to implement this collaboration will be in Chagrin Falls at 16801 Chillicothe Rd., effective January 2009, with the rest to follow throughout the year. Signs inside and outside the stores will notify customers that each site is collaborating with Cleveland Clinic.

As part of the collaboration, Cleveland Clinic and MinuteClinic will fully integrate their electronic medical records (EMR) systems to streamline communication around all aspects of a patient's care. The MinuteClinic EMR also includes an advanced e-prescribing program. Each Cleveland Clinic-affiliated MinuteClinic will have access (with patient consent) to a patient's Cleveland Clinic MyChart electronic medical record -- which includes medical history, prescriptions, treatments and health maintenance information. At the patient's request, MinuteClinic will share its patient information with other Cleveland Clinic-affiliated locations in Northeast Ohio via the MinuteClinic EMR for MinuteClinic patients who have been treated in those locations.

"We are pleased to be working with one of the leading medical institutions in the United States to expand access to basic health care needs in the Cleveland community," said Chip Phillips, MinuteClinic president. "Through this agreement, Cleveland Clinic's family physicians will serve as a valuable resource to our MinuteClinic nurse practitioners in Northeast Ohio and we look forward to collaborating with Cleveland Clinic on a range of patient education and preventive services."

More Physicians Migrate to e-Prescribing

An article in the St. Louis Post-Dispatch indicates that "more hospitals and clinics are tossing their prescription pads and sending medication orders to pharmacies electronically." But adoption has been slow. However, the new Medicare physician incentive is helping with e-prescribing acceptance.

"We like it because it's easy to read," said Nimita Thekkepat, a Walgreens pharmacist in St. Louis and assistant professor at St. Louis College of Pharmacy. "A lot of medication errors can really be eliminated."

According to the Institute of Medicine, medication errors sicken, injure or kill more than 1.5 million Americans each year. The most common errors include prescriptions for the wrong dosage, the wrong medication or for drugs with dangerous interactions. The cost of the errors was estimated
to be at least $3.5 billion a year.

Congress requested the report as part of its 2003 Medicare Modernization Act.  Electronic prescribing was one of the solutions outlined in the legislation.

Doctors and hospitals have been slow to adopt the technology. The software can cost up to $2,500, and it requires some training. And like surgeons before them who traded scalpels for lasers, some doctors are reluctant to eliminate paper.

Thekkepat estimates that 10 percent to 15 percent of the prescriptions filled at local Walgreens are sent electronically — about the same as the national average.

Doctors who prescribe electronically say they appreciate the additional checkpoint for errors.  "Doctors are not infallible, we make mistakes," said Dr. Jay Moore, an internist in Wentzville who helps SSM Health Care with their transition to electronic medicine. "If I send a prescription for Augmentin and the patient is allergic to penicillin, the computer will tell me, 'Hey, you're not supposed to prescribe this, the patient is allergic.'"

Not that the technology totally eliminates errors. Typos happen, and a wayward click can send the wrong drug or strength. Still, it's a step toward improving communication between the doctor's office and the pharmacy.  For doctors who e-prescribe a percentage of their medications, Medicare now offers a 2 percent payout on top of the doctor's services covered by the federal insurance's Part B plan. By 2012, Medicare will start reducing payments to physicians who aren't using e-prescribing technology.

E-Prescribing Takes Center Stage in Stimulus Packages

Economic stimulus legislation making its way through the U.S. Congress includes about $20 billion to accelerate the adoption of health information technology including electronic prescribing solutions.  President Barack Obama has made e-prescribing a central element of his plan to improve the U.S. healthcare system. Here are some facts about health information technology.

* E-prescribing replaces paper prescriptions. Instead, a doctor electronically transmits a prescription to the pharmacist.

* Electronic medical records replace paper records, which must be copied and mailed or physically taken from one healthcare provider to another.

* Experts say using electronic medical records can reduce errors, improve coordination and cut administrative costs. One challenge is making the technology interoperable so systems can be accessed by a variety of healthcare providers. CCHIT certification should be an essential part of decision making by providers.

* President Obama has pledged to spend $50 billion over five years to develop health information technology. Potential savings are estimated at $90 billion over 10 years. 

* According to CHT member SureScripts-RxHub, an estimated 12 percent of U.S. doctors -- about 70,000 -- use e-prescribing, double the figure from a year ago. 

* E-prescribing is more efficient for the health system and cuts down on medical errors, such as getting the wrong medication because of a doctor's poor handwriting or getting the wrong drug because it has a name similar to another one.

* Physicians using an e-prescribing system which includes prescription drug pricing are more likely to prescribe less expensive generics.

* Physicians who treat Medicare patients can receive financial bonuses for using e-prescribing. Doctors who do not will face penalties from Medicare starting in 2012.

* The cost of software and training are viewed as a barrier to doctors who have not yet adopted e-prescribing. But, a coalition of healthcare and technology companies -- the National e-Prescribing Pateint Safety Initiative -- offers e-prescribing software from Allscripts to any doctor free of charge. Visit http://www.nationalerx.com/ for more details.

Georgia's Dedication to HIT Adoption Published by HIMSS

 

Renea Steele, the Director of the Office of Health Information Technology for the Georgia Department of Community Health has published an article in the HIMSS Newsletter entitled "Georgia Promotes the Use of HIE to Transform its Healthcare Delivery System." Here is the text of that article:

The Georgia Department of Community Health (DCH) has the responsibility for insuring over two million people in the state of Georgia, maximizing the state’s health care purchasing power, coordinating health planning for state agencies and proposing cost-effective solutions for reducing the number of uninsured.

Under an Executive Order issued by Governor Sonny Perdue in October 2006, the Georgia Health Information Technology and Transparency (HITT) Advisory Board was established to advise DCH on the best practices for encouraging the use of electronic health records and establishing a statewide strategy to enable health information to be readily available and transparent.  Georgia’s goals for health information technology are to enable the comprehensive timely and secure communication of health information across the public and private sectors for the benefit of the health care consumer.

Recognizing that health information exchange depends on the use of effective, user-friendly health information technology in the patient care environment, the Executive Order charged the HITT Advisory Board with fostering the development of e-prescribing capabilities and electronic health record systems in Georgia.  The Board was also charged with developing a statewide vision for the adoption of interoperable health information technology to enable the following benefits to Georgians:

• Improved patient safety
• Improved quality of care
• Improved clinical and administrative efficiency
• Improved detection of epidemic threats, both natural and man-made
• Cost savings
• Health care consumer empowerment through improved access to personal health information
• Advancements in public health and medical research

Funding

To this end, state funding has been provided to move the health care industry in Georgia to adopt electronic health records and establish interoperability through the Health Information Exchange (HIE) Grant Pilot Program.  In November 2007, DCH awarded $853,088 in matching grants to four health care organizations for improving both health care services and public health.  The Georgia HIE grantees aimed to improve access to comprehensive patient health information created by multiple providers and to decrease prescription errors linked to illegible handwriting or insufficient information.  The awardees matched the funds given to them by the state.

DCH launched a second round of HIE grant awards, and in November 2008 awards were made totaling $750,000.00 to three organizations: Chatham County Safety Planning Council, Saint Joseph of East Georgia and Washington County Regional Hospital.  Two of the grantees who received awards both years, Chatham and Washington Counties, will expand on their first-year projects by implementing electronic medical records and sharing information among hospitals, pubic health clinics and primary health care physicians in their geographic areas.

Strategic Approach and Accomplishments

Best practices, accomplishments and lessons learned from the pilot programs will be used to further the strategic efforts of Georgia for statewide HIE.  Georgia’s HITT initiative is about using technology to empower consumers to make informed health care decisions.  HIE will improve patient safety, quality of care, and patient and physician access to a patient’s health information.

The Office of Health Information Technology and Transparency (HITT) was established in January 2008 within Georgia’s Department of Community Health.  The office is  responsible for leading the strategic efforts of the State of Georgia for health information technology adoption and health information exchange between health care providers to improve health care delivery for providers, health care professionals and consumers.

HITT accomplishments:

• Centers for Medicare & Medicaid Services awarded DCH a Medicaid Transformation to assist with the implementation of Georgia’s Transparency Web Site for Health Care Consumers
• Issued HIE grants to organizations that will help foster the development of HIE, electronic prescribing, and/or adoption of electronic medical records across Georgia
• Selected to participate in the Health Information Security and Privacy Collaborative with seven other states
• Contracted with IBM to develop Transparency Web site
• Announced the Georgia Rx Exchange

• Georgia selected to a be pilot site for the Medicare Demonstration Project

• Launched georgiahealthinfo.gov, the state’s Transparency Web Site for Health Care Consumers

• Kick-off the Medicaid Electronic Health Record project

Details of HIT Provisions in House Version of Stimulus Package

House Democratic passed the American Recovery and Reinvestment Bill of 2009 (HR 1). The House action -- which was along party lines -- was the latest step in an effort to get economic stimulus legislation to President Obama's desk before the Presidents Day recess in mid-February. The Senate is expected to vote on its version of the legislation soon, which includes different tax provisions and might win more Republican support.

The health care provisions in the House's $825 billion bill include (1) state fiscal relief through Medicaid, (2) help for working families hurt by the economic downturn, and (3) job-creating investments in health information technology.

Here are the provisions of the investments in health care:

The bill contains health information technology (HIT) requirements that are designed to create jobs in health care. These provisions are estimated to cost $17.9 billion and would:

• Require the Secretary of HHS to implement an ongoing process for the development and adoption of HIT standards (for interoperability and minimum functionality), including the certification of systems as meeting those standards.
• Invest in the adoption and use of HIT systems by health care providers who serve Medicare and Medicaid patients.
• Beginning in 2011, pay participating Medicare providers temporary bonus payments if they exhibit to the Secretary that they are meaningfully using a certified HIT system; those who do not eventually meaningfully use certified HIT would not receive full Medicare payments. Hardship exceptions would be available to providers who face significant barriers to adoption, such as limited access to the Internet.
• Beginning in 2011, pay high-volume Medicaid providers a temporary payment to subsidize the adoption of a certified HIT system. Also beginning in 2011, high-volume Medicaid providers who meaningfully use certified HIT would be eligible for a temporary payment to offset the ongoing costs of supporting, maintaining, or upgrading certified HIT systems.
• Require the Secretary of HHS to adopt measures for determining the meaningful use of a certified HIT system. At minimum, measures would include the use of electronic prescribing technology, the exchange of health information with other providers to help coordinate care, and the reporting of clinical quality measures.

President Obama said he was grateful for the House vote on the economic package but hopes the Senate will "strengthen" the plan before it reaches his desk. Mr. Obama said the House package will provide "billions of dollars of immediate tax relief "to working families and save or create 3 million jobs over the new few years. Earlier in the day after a meeting with business leaders, the president said he hoped to sign an economic recovery bill "in the next few weeks."